UnitedHealthcare implements Smart Edits into the EDI claim process In the April 2018 UnitedHealthcare (UHC) network bulletin, UHC notified physicians that it would implement Smart Edits, a new functionality introduced into the EDI workflow, allowing the payor to autodetect claims with potential errors in the claims pre-adjudication phase. Once a potential error has been identified, UHC will notify the physician (via the 277CA report) within 24 hours, returning the claim to the provider along with a suggested modification to overcome the problem. Providers will have five calendar days to correct the claim and resubmit it, reducing the potential ... June 14, 2018 United Healthcare claims, edits, uhc 0 0 Comment Read More »
CMA urges Health Net to rescind recently announced payment policies Since Health Net first notified physicians in March of planned changes to its modifier 25 and emergency services payment policies for Medicare and Medi-Cal lines of business, the California Medical Association (CMA) has been working to educate the payor about physician concerns with the new policies. Last month, at CMA’s urging, Health Net agreed to delay implementation of the new policies until July 1, 2018, to allow time to review provider concerns with the new policies and to continue discussions with CMA and other stakeholders. CMA recently wrote to Health Net ... June 14, 2018 CMA, Health Net 0 0 Comment Read More »
Award Honors To 10 Deserving Physicians and Community Leaders The Santa Clara County Medical Association hosted nearly 200 members and their families for our Annual Awards Banquet where we awarded top honors in nine categories as well welcomed our new 2018-19 President, Kenneth Blumenfeld, MD. 2018 Award Winners: Outstanding Contribution to the Medical Association Thomas Dailey MD Outstanding Contribution in Medical Education John Tatman, MD Outstanding Achievement in Medicine Ruma Kumar, MD Outstanding Contribution in Community Service Suchada Nopachai, MD William C. Parrish Jr. Leadership in Healthcare Award William Parrish Jr. Citizen's Award John and Gini Mitchem Special Recognition Award SCCMA Alliance Foundation Accepted by Suzanne Jackson Benjamin Cory, MD Award Sameer Awsare, MD Robert D. Burnett, ... June 13, 2018 General Honorees, Awards 0 0 Comment Read More »
Blue Shield of California and CMA collaborate to build health care model of the future June 12, 2018 Blue Shield, General 0 0 Comment Read More »
Warning: Beware of Doctor SCAM with DEA Posers The Drug Enforcement Administration is warning the public about criminals posing as DEA Special Agents or other law enforcement personnel as part of an international extortion scheme. The criminals call the victims and identify themselves as DEA agents or law enforcement officials from other agencies. The impersonators inform their victims that purchasing drugs over the internet or by telephone is illegal, and that enforcement action will be taken against them unless they pay a fine. In most cases, the impersonators instruct their victims to pay the "fine" via wire transfer ... May 23, 2018 DEA, Public Health DEA, POSERS, SCAM 0 0 Comment Read More »
